Table 1.
Association of Observed Patient and Hospital Characteristics and Outcomes With Initial Antibiotic Treatment
| Characteristics | Total | Macrolide Before Cephalosporin | Cephalosporin Before Macrolide | P Valuea |
|---|---|---|---|---|
| n (%) | n (%) | n (%) | ||
| N | 2711 (100) | 539 (19.9) | 2172 (80.1) | |
| Age, median (IQR), years | 71 (55–83) | 68 (53–81) | 72 (56–83) | .03 |
| Gender | .17 | |||
| Male | 1296 (47.8) | 246 (45.6) | 1050 (48.3) | |
| Female | 1415 (52.2) | 293 (54.4) | 1122 (51.7) | |
| Race/Ethnicity | .85 | |||
| White | 2145 (79.1) | 414 (76.8) | 1731 (79.7) | |
| Black | 351 (12.9) | 80 (14.8) | 271 (12.5) | |
| Hispanic | 61 (2.3) | 15 (2.8) | 46 (2.1) | |
| Other | 154 (5.7) | 30 (5.6) | 124 (5.7) | |
| Insurance Payer | .14 | |||
| Medicare | 1209 (44.6) | 200 (37.1) | 1009 (46.5) | |
| Medicaid | 132 (4.9) | 28 (5.2) | 104 (4.8) | |
| Other | 1370 (50.5) | 311 (57.7) | 1059 (48.8) | |
| LAPS, median (IQR) | 41 (29–55) | 40 (28–53) | 41 (30–55) | .22 |
| Principal Diagnosis | .04 | |||
| Pneumonia | 2109 (77.8) | 437 (81.1) | 1672 (77) | |
| ARF | 161 (5.9) | 28 (5.2) | 133 (6.1) | |
| Sepsis | 441 (16.3) | 74 (13.7) | 367 (16.9) | |
| Type of Pneumonia | ||||
| CAP | 1864 (68.8) | 359 (66.6) | 1505 (69.3) | |
| HCAP | 847 (31.2) | 180 (33.4) | 667 (30.7) | |
| Gagne combined score, median (IQR) | 2 (1–4) | 2 (1–3) | 2 (1–4) | .55 |
| Comorbiditiesb | ||||
| Hypertension | 1255 (46.3) | 239 (44.3) | 1016 (46.8) | .74 |
| Chronic pulmonary disease | 1163 (42.9) | 259 (48.1) | 904 (41.6) | .005 |
| Smoking | 758 (28.0) | 156 (28.9) | 602 (27.7) | .54 |
| Diabetes | 737 (27.2) | 155 (28.8) | 582 (26.8) | .08 |
| Chronic blood loss anemia/deficiency anemias | 669 (24.7) | 110 (20.4) | 559 (25.7) | .04 |
| Congestive heart failure | 620 (22.9) | 118 (21.9) | 502 (23.1) | .99 |
| Renal failure | 381 (14.1) | 76 (14.1) | 305 (14.0) | .74 |
| Other neurological disorders | 345 (12.7) | 64 (11.9) | 281 (12.9) | .95 |
| Depression/psychoses | 333 (12.3) | 66 (12.2) | 267 (12.3) | .63 |
| Hypothyroidism | 314 (11.6) | 54 (10.0) | 260 (12.0) | .24 |
| Obesity | 246 (9.1) | 59 (10.9) | 187 (8.6) | .07 |
| Valvular disease | 204 (7.5) | 37 (6.9) | 167 (7.7) | .92 |
| Metastatic cancer/solid tumor without metastasis | 167 (6.2) | 34 (6.3) | 133 (6.1) | .84 |
| Weight loss | 169 (6.2) | 33 (6.1) | 136 (6.3) | .61 |
| Peripheral vascular disease | 138 (5.1) | 21 (3.9) | 117 (5.4) | .35 |
| Pulmonary circulation disease | 137 (5.1) | 28 (5.2) | 109 (5.0) | .61 |
| Prior Year Receipt of IMV | ||||
| 0 | 2668 (98.4) | 530 (98.3) | 2138 (98.4) | |
| 1 time | 38 (1.4) | 9 (1.7) | 29 (1.3) | |
| 2 or more times | 5 (0.2) | 5 (0.2) | ||
| Prior Year Receipt of NIV | .03 | |||
| 0 | 2676 (98.7) | 528 (98) | 2148 (98.9) | |
| 1 time | 21 (0.8) | 5 (0.9) | 16 (0.7) | |
| 2 or more times | 14 (0.5) | 6 (1.1) | 8 (0.4) | |
| Prior Year Admissions | .19 | |||
| 0 | 1610 (59.4) | 309 (57.3) | 1301 (59.9) | |
| 1 time | 560 (20.7) | 115 (21.3) | 445 (20.5) | |
| 2 or more times | 541 (20) | 115 (21.3) | 426 (19.6) | |
| Initial Care Venue | .09 | |||
| Ward | 2265 (83.5) | 470 (87.2) | 1795 (82.6) | |
| Intensive Care Unit | 324 (12) | 51 (9.5) | 273 (12.6) | |
| Intermediate care | 122 (4.5) | 18 (3.3) | 104 (4.8) | |
| Vasopressors (before 1st abx) | 23 (0.8) | 13 (2.4) | 10 (0.5) | <.001 |
| Vasopressors (before 1st abx or ≤12 hrs after 1st abx) | 111 (4.1) | 22 (4.1) | 89 (4.1) | .83 |
| NIV (before 1st abx) | 62 (2.3) | 15 (2.8) | 47 (2.2) | .04 |
| NIV (before 1st abx or ≤12 hrs after 1st abx) | 78 (2.9) | 17 (3.2) | 61 (2.8) | .1 |
| IMV (before 1st abx) | 97 (3.6) | 22 (4.1) | 75 (3.5) | .5 |
| IMV (before 1st abx or ≤12 hrs after 1st abx) | 128 (4.7) | 26 (4.8) | 102 (4.7) | .81 |
| Hospital Region | .07 | |||
| Midwest | 465 (17.2) | 108 (20) | 357 (16.4) | |
| Northeast | 1093 (40.3) | 216 (40.1) | 877 (40.4) | |
| South | 894 (33) | 166 (30.8) | 728 (33.5) | |
| West | 259 (9.6) | 49 (9.1) | 210 (9.7) | |
| Hospital size | .51 | |||
| 6–199 beds | 848 (31.3) | 144 (26.7) | 704 (32.4) | |
| 200–499 beds | 1419 (52.3) | 296 (54.9) | 1123 (51.7) | |
| 500 and more beds | 444 (16.4) | 99 (18.4) | 345 (15.9) | |
| Hospital Teaching Status | .001 | |||
| Nonteaching | 1099 (40.5) | 160 (29.7) | 939 (43.2) | |
| Teaching | 1612 (59.5) | 379 (70.3) | 1233 (56.8) | |
| Outcomes | ||||
| Clinical Deterioration | ||||
| Late NIV | 25 (0.9) | 3 (0.6) | 22 (1) | .35 |
| Late IMV | 64 (2.5) | 13 (2.5) | 51 (2.5) | .9 |
| Late vasopressors | 90 (3.5) | 23 (4.4) | 67 (3.2) | .29 |
| In-hospital mortality | 151 (5.6) | 22 (4.1) | 129 (5.9) | .07 |
| In-hospital mortality/hospice discharge | 216 (8.0) | 33 (6.1) | 183 (8.4) | .09 |
| LOS, median (IQR), hours | 102.8 (67.9–166.0) | 102.6 (70.0–169.6) | 103.2 (67.2–164.4) | .05 |
| Readmission within 30 days (among survivors) | 319 (12.5) | 65 (12.6) | 254 (12.4) | .97 |
| Discharge disposition (among survivors, nonhospice discharges, n = 2150) | .11 | |||
| Home/home-health | 1795 (71.9) | 379 (74.9) | 1416 (70.2) | |
| SNF/ICF | 627 (25.1) | 118 (23.3) | 509 (25.6) | |
| Other | 73 (2.9) | 9 (1.8) | 64 (3.2) | |
Abbreviations: abx, antibiotic; ARF, acute respiratory failure; CAP, community acquired pneumonia; GEE, generalized estimating equation; HCAP, healthcare-associated pneumonia; ICF, intermediate care facility; IMV, invasive mechanical ventilation; IQR, interquartile range; LAPS, Laboratory Acute Physiology Score; LOS, length of stay; NIV, noninvasive mechanical ventilation; SNF, skilled nursing facility.
a P value from GEE models accounting for patient clustering within hospitals.
bComorbidities with at least 5% prevalence are presented.